Large Pedunculated Polyps Research Articles

574 Role of Prophylactic Endoscopic Clipping for Prevention of Delayed Post-Polypectomy Bleeding: Meta-Analysis of Randomized Controlled Trials

INTRODUCTION: Post-polypectomy bleeding is a common complication of colonoscopy. Several endoscopic techniques including prophylactic endoscopic clip placement are used for prevention of post-polypectomy bleeding. However, several studies have reported mixed results on the efficacy of this approach. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of prophylactic endoscopic clipping for prevention of delayed post-polypectomy bleeding. METHODS: Several databases (Embase, Pubmed, Cochrane database, Google Scholar) and abstracts of gastrointestinal and surgical meetings were searched extensively for relevant articles. Studies comparing prophylactic endoscopic clipping alone to standard colonoscopy with no endoscopic clipping were included. Studies that combined prophylactic clipping with other hemostatic techniques were excluded. Data was extracted using a standard form by two reviewers. Data regarding patient characteristics, types of polyps resected, post-polypectomy bleeding and other complications were extracted. Effect sizes were computed either using the fixed effects or random effects model using the Comprehensive Meta-analysis software. Publication bias, quality of studies and heterogeneity were analyzed. RESULTS: Nine RCTs were included in this study. The studies recruited subjects from USA, Japan, Canada and Spain. There were 3762 controls and 3658 patients in the treatment arm. Studies evaluated both small (<20mm) and large polyps (>20 mm), sessile and pedunculated polyps. The polyps were predominantly removed with standard polypectomy or endoscopic mucosal resection (for larger polyps). Delayed post-polypectomy bleeding occurred in 2.4% of controls and 1.6% in patients with endoscopic clipping. On analysis of all polyps, prophylactic endoscopic clipping decreased the risk of delayed post-polypectomy bleeding (RR = 0.71: 95% CI 0.51-0.99, P = 0.04, I2= 20%). The risk reduction was seen mainly with larger polyps(>20 mm), RR = 0.53 (95% CI : 0.32-.90, P = 0.02, NNT 28) and with sessile polyps (RR = 0.52, 95% CI: 0.32-0.83, P = 0.006, NNT 100). The protective effect was not seen for small polyps (<20 mm) (P = 0.91, P = 0.7) or pedunculated polyps (RR = 0.58, P = 0.29). All studies were of high quality. No publication bias or heterogeneity was present. CONCLUSION: Prophylactic clipping decreased the risk of delayed post-polypectomy bleeding. The benefit was mainly seen in patients with sessile polyps or large polyps (>20 mm).

Tu1945 A NOVEL TECHNIQUE USING ENDOSCOPIC BAND LIGATION FOR REMOVAL OF LONG-STALKED PEDUNCULATED COLON POLYP

Bleeding is the most common complication associated with polypectomy of large pedunculated colonic polyp. Although several techniques have been developed to minimize bleeding, none of these methods has become the gold standard. To prevent post-polypectomy bleeding effectively, we developed and attempted a new endoscopic technique for removal of large long-stalked pedunculated colonic polyps using band ligations.

Risk Factors for Delayed Hemorrhage after Colonic Endoscopic Mucosal Resection in Patients Not on Antithrombotic Therapy: Retrospective Analysis of 3,844 Polyps of 1,660 Patients

Background/Aims: Colonic endoscopic mucosal resection (EMR) is safe for patients without antithrombotic therapy; however, EMR is associated with several risks. This study was performed to evaluate the risk of delayed hemorrhage in patients undergoing EMR without antithrombotic therapy. Methods: In the present retrospective single-center study, 1,792 patients without antithrombotic therapy underwent colonic EMR from March 2012 to December 2016 at the Saga Medical Centre Koseikan. Risk factors were evaluated with respect to patient and lesion characteristics, the endoscopist’s experience, and preventive hemoclips. Delayed hemorrhage was defined as bleeding for which emergency endoscopic hemostasis was applied >24 h after EMR. Results: Among the 1,792 patients, 1,660 with 3,844 tumors were evaluated. Delayed hemorrhage occurred in 43 patients (2.6%) and 46 polyps (1.2%). Preventive hemoclips were applied in 996 patients (60.0%). Univariate analysis indicated that delayed hemorrhage occurred more frequently in young patients (3–39 years, p < 0.001, 40–59 years, p = 0.005) compared to > 60 years and in association with large polyps (> 10 mm, p = 0.003), hemoclip (p = 0.019), and pedunculated polyps (p = 0.024). Multivariate analysis indicated that risk factors for hemorrhage were young age (age of 3–39 years p < 0.001, 40–59 years, p = 0.005) and large polyps (> 10 mm, p < 0.001). The risk of delayed hemorrhage was increased by an estimated 8% with a 1-mm increase in polyp size. Conclusion: The present study suggests that young age (under 60 years old) and large polyp size are risk factors for causing delayed hemorrhage after colonic EMR in patients without antithrombotic therapy.

The Risk of Recurrence due to Incomplete Resection of 10-20mm Polyps

Introduction: Post-colonoscopy colorectal cancer in a colon segment of a previously removed polyp has been used to adjudicate incomplete resection (IR) as the underlying etiology. Although incomplete removal of large (10-20mm) non-pedunculated polyps is common (17% in the CARE study), the clinical importance of residual polyp tissue remains unclear. Aim: To estimate the risk of metachronous neoplasia due to IR (MIR) of neoplastic 10-20mm polyps. Methods: We built our analysis based on the assumption that MIR can be estimated as the difference between metachronous polyps found in a segment with a previously removed polyp and segments without any previous polyps (Risk of metachronous neoplasia=Risk of de novo lesion+Risk of missed lesion+Risk of IR). We abstracted data on all patients who had a large (10-20mm) polyp resection at two academic medical centers from 2000 to 2012 and a first surveillance colonoscopy within 0.5 to 5 years. Our primary outcome was the MIR following resection among all colon segments with a prior single 10-20mm neoplastic polyp. Metachronous neoplasia was defined as the presence of at least one neoplastic polyp in a colon segment at follow-up. We further examined if polyp morphology, mode of resection, and histology were associated with incomplete resection. Results: We identified 1039 patients (mean age 62, 70.3% men) with a median of 36 months to their surveillance exam (IQR 28). The absolute risk of metachronous neoplasia for segments without any neoplastic polyps at baseline was 10.3%, compared to 23.3% for segments with a single large polyp at baseline (P<0.001) (Figure), resulting in a 13.0% risk of MIR. This risk was higher for large sessile polyps (18.2%) than large pedunculated polyps (3.8%, P<0.001; Table). MIR was less likely following en-bloc resection (9.2%) than piecemeal resection (28.0%, P<0.001). Polyp histology only affected MIR following piecemeal resection: 15.6% for sessile serrated adenomas, 25.0% for tubular adenomas, and 42.1% for advanced adenomas.FigureTable: Table. Risk of metachronous neoplasia in colon segments with a prior single 10-20mm neoplastic polyp in reference to colon segments without any prior neoplastic polypConclusion: Applying a novel approach, this longitudinal study showed that incomplete resection of 10-20mm neoplastic polyps contributed 13% to metachronous neoplasia. This estimate increases to 18% for non-pedunculated large polyps, similar to the reported 17% in the cross-sectional CARE study. Our findings provide a strong argument that incomplete resection matters, although a field effect cannot be completely excluded.

Endoscopic resection using the Clutch Cutter and a detachable snare for large pedunculated colonic polyps.

Background and study aims Endoscopic snare polypectomy with prophylactic detachable snare of large pedunculated colonic polyps (PCPs) is technically demanding. To facilitate removal of such polyps, we developed endoscopic resection using the Clutch Cutter and a detachable snare (ERCCDS). This study aimed to evaluate the efficacy and safety of the procedure. Patients and methods From April 2010 to July 2015, 14 consecutive patients who had PCPs with head > 10 mm, stalk width > 5 mm, and stalk length > 10 mm were enrolled in this single-center prospective uncontrolled study. They were treated using ERCCDS by a single endoscopist. The efficacy and safety were assessed using a database prospectively formatted from the medical records. Results The Clutch Cutter was able to cut the distal side of the stalk an adequate distance from the detachable snare under good visual control. R0 resections were obtained in all lesions. There were no immediate or delayed complications. Conclusions ERCCDS appears to be a safe, easy, and technically efficient method for large PCPs, although larger studies are needed to compare ERCCDS and standard resection.

OC-046 The ACPGBI/BSG Complex Colorectal Polyp Minimum Dataset: An Update

Introduction Variation in the assessment of large non-pedunculated colorectal polyps (LNPCPs) appears to lead to variable and suboptimal management outcomes. 1 Multidisciplinary discussion has been advocated to optimise management. Our ACPGBI/BSG evidence-based, expert consensus minimum dataset developed in 2014–15 has been felt to enhance LNPCP assessment and decision making. 2 We propose that further refinement will ensure increased robustness. Methods A 14 person ACPGBI/BSG approved multidisciplinary panel reassessed the original minimum dataset using Delphi consensus methodology. A subcommittee tested the proforma dataset’s applicability and usability for multidisciplinary discussion over 20 LNPCP cases. This process was intended to find any previously unidentified patient and polyp factors that may influence management. Proposed additional parameters were then subject to voting with >80% agreement required for consensus. The updated dataset was then assessed with a further 20 LNPCP cases. Results 8 new parameters considered helpful for LNPCP assessment were identified. Whilst patient parameters such as symptoms, treatment preferences and comorbidity had previously been identified, it was agreed that establishing patient amenability to undergo treatment at another hospital was important and may potentially increase available therapeutic options. With regards to lesion characteristics, it was felt that specification of the ‘SMSA scoring system’ encouraged more comprehensive and standardised lesion assessment of the complexity of lesion endoscopic resectability. 2 Comprehensive photodocumentation was also considered necessary with parameters agreed relating to the capture of morphology and surface features and specific rectal imaging. Further piloting of the revised dataset identified no further required parameters (see figure). Conclusion The development of an ACPGBI/BSG minimum dataset allows for comprehensive and standardised multidisciplinary LNPCP assessment. It forms part of a structured ACPGBI/BSG management framework for LNPCPs, also comprising guidelines and key performance indicators. In addition to facilitating multidisciplinary discussion, the dataset can also serve as an aide memoire to guide detailed endoscopic assessment. The updated consensus process ensures that all factors pertinent to decision making are included whilst applicability and usability are confirmed following further piloting. References 1 Chattree A, Painter J, Silcock J, et al . Marked Variation in Endoscopic Mucosal Resection Outcomes within the UK Bowel Cancer Screening Programme. United European Gastroenterology Journal 2015; 2 (Supp 1) 2 Rutter MD, Chattree A, Barbour J, et al . BSG/ACPGBI Guidelines for the management of large non pedunculated colorectal polyps. Gut 2015; 0 :1–27 Disclosure of Interest None Declared

Comparison of clipping with and without epinephrine injection for the prevention of post-polypectomy bleeding in pedunculated colon polyps.

Post-polypectomy bleeding (PPB) is the most common adverse event of colonoscopic polypectomy, especially in cases with large pedunculated polyps. To minimize the risk of PPB, several endoscopic preventive methods have been performed. The aim of this prospective, randomized study was to compare the rates of PPB following single (clipping alone) and combined (clipping plus epinephrine-saline injection) methods in prevention of PPB in large pedunculated polyps. Adult patients with pedunculated colorectal polyps with heads ≥ 10 mm were prospectively enrolled from March 2011 to January 2013. Patients were randomized to receive treatment of either clips alone (group A) or clips plus injection of epinephrine-saline (group B) prior to a conventional polypectomy. PPB rate in both groups were compared. A total of 148 patients with 173 pedunculated colorectal polyps were enrolled. Groups A and B each had 74 patients, with 83 and 90 polyps, respectively. The mean head diameters were 17.2 ± 6.6 and 17.5 ± 6.7 mm in groups A and B, respectively (P = 0.748). Immediate PPB (IPPB) occurred in 10 cases (12.0%) from group A and 13 cases (14.4%) from group B (P = 0.64). There were no cases of delayed PPB or perforation. Multivariate analysis showed that inadequate bowel preparation and large head diameter of polyp were independent risk factors for IPPB. The rate of IPPB is relatively high in cases with large pedunculated polyps, but these polyps can be successfully resected by snare polypectomy following use of the single prophylactic clipping method.

Grasping forceps assisted endoloop/snare polypectomy of a giant duodenal hamartoma.

A 42-year-old man underwent esophagogastroduodenoscopy (EGD) at our institute for melena with severe anemization. A giant polypoid lesion with some superficial erosions was found at the proximal descending part of duodenum, next to the upper angle. The lesion had a maximum transverse diameter of 4 cm, with an overall length of 7 cm (Figure 1(a)). Histology revealed Brunner’s gland hyperplasia. Figure 1. Endoscopic images before endoscopic removal (a), during forceps-assisted endoloop placement (b), and during (c) and following polypectomy (d). Due to the lesion size and location, endoscopic resection was performed under general anesthesia with a double-channel endoscope (Olympus Medical, Center Valley, PA, USA) in order to use more accessories simultaneously. The lesion was held with grasping forceps inserted through a detachable snare loop (Endoloop; Olympus America, Center Valley, PA, USA), which was then advanced, tightened and detached at the base of the lesion to prevent bleeding (Figure 1(b)). With the grasping forceps inserted through a polypectomy snare (AcuSnare, Wilson-Cook Medical, Inc., Winston-Salem, NC, USA), the lesion was finally ensnared, and resection was performed under direct vision between the grasping forceps and the endoloop (Figure 1(c) and (d)). No adverse events occurred and the patient was discharged the next day. Histology showed a Brunner’s gland hamartoma (Figure 2). No more episodes of bleeding were observed, with no lesion recurrence at 6 month endoscopy follow up (Figure 3). Figure 2. Histological images at 0.039× magnification of the Brunner’s gland hamartoma, stained with hematoxylin-eosin (a), Alcian-PAS (b) and SMA (c), highlighting the glandular PAS positive component (white*), the muscular (red*) and the vascular ... Figure 3. Narrow band imaging (NBI) endoscopic view at 6 month follow up. Brunner’s gland hamartoma is a rare tumor-like lesion, with an average size of 2 cm, rarely larger than 5 cm, that locates in the first portion of duodenum; its pathogenesis is unknown and malignant change is rarely observed [Levine et al. 1995; Kim et al. 2013]. Clinical presentation of Brunner’s gland hamartoma is variable. Obstruction and gastrointestinal bleeding are the most common clinical manifestations [Chen et al. 2005]. If local surgical resection of this lesion via duodenotomy is described for those large lesions (up to 6 cm in diameter) [Levine et al. 1995], endoscopic polypectomy has also been reported as a safe and less invasive treatment for smaller pedunculated hamartomas [Walden and Marcon, 1998; Chen et al. 2005]. Endoscopic removal of large pedunculated polyps is technically demanding because a large polyp on a long and thick stalk may move relatively freely within the lumen, making the ensnaring of the polyp very difficult. Furthermore the unique anatomical features of the duodenum, such as the relatively small size of the lumen, make it even much more challenging. The grasping forceps assisted technique appeared as a very helpful endoscopic approach for resection of this polyp, avoiding any surgical intervention for removal of such a benign lesion. The grasping forceps assisted technique was first reported by Akahoshi and colleagues for removal of colonic and gastric pedunculated polyps with an average diameter of 19 mm (range from 11 to 30 mm) [Akahoshi et al. 1999]. To the best of our knowledge, this is the first application of this technique in the duodenum. This new alternative approach for removal of large benign peduncolated lesions such as duodenal hamartomas seems to be useful and safe, avoiding surgery with its associated costs, postoperative length of stay and complications.

Use of dual knife for large pedunculated colorectal polyps.

Endoscopic resection of large pedunculated colorectal polyps is technically difficult, especially when the polyps are so large that it is either not possible or too difficult to resect them using a conventional polypectomy snare. To facilitate the removal of pedunculated colorectal polyps, we developed a new technique using a combination of a dual knife and preventive hemostatic procedures. Nine patients (5 men and 4 women; mean age, 59.8 y; range, 49 to 79 y) with pedunculated polyps >2 cm in diameter were treated with this technique. A dual knife and endoclips or an endoloop were used as needed. All lesions, except for 1 polyp, were resected endoscopically. The mean time for complete resection was 8.5 minutes (range, 1.5 to 16 min). The procedure time decreased significantly after the fifth case (168 vs. 746 s, P=0.0009). No hemorrhage, perforation, or other complications occurred during follow-up among the endoscopically resected cases. Combined use of a dual knife and prophylactic hemostatic procedures is a feasible alternative technique for removing large pedunculated colorectal polyps when conventional snare resection is impossible or difficult.

The role of gastrointestinal endoscopy nurses in high risk colorectal polypectomy. Prevention of complications in one or two steps

Introduction: The endoscopic polypectomy of large pedunculated or sessile polyps involves many kinds of high risk complications, such as the haemorrhage: the occurrence of which, according to published reports varies between 0.3% and 6.1%. The most severe complication is perforation.

A Woman With Melena and Transfusion-Dependent Anemia

Question: A 47year-old woman withhamartomatous gastric polyposiswas referred for total gastrectomy because of transfusiondependent iron deficiency anemia owing to blood loss. The patient’s history included life-long, recurrent epistaxis requiring electrocautery of the nasopharynx and subtotal colectomy for juvenile colonic polyps. Physical examination revealed small telangiectasias over the bilateral cheeks and hard palate. Both the prior colectomy specimen and endoscopic gastric biopsies demonstrated juvenile hamartomatous polyps. Abdominal computed tomography obtained 1-year prior showed gastric polyposis (Figure A, arrow) and subtle enhancing hepatic lesions. Abdominal magnetic resonance imaging determined these to be hepatic vascular malformations. An upper endoscopy revealed numerous large pedunculated and sessile bleeding gastric polyps that carpeted the stomach (FigureB). Laparoscopic total gastrectomywith esophagojejunostomy and Roux-en-Y reconstructionwas performed. The gross specimen showed innumerable polyps ranging in size from 0.3 to 4.0 cm (Figure C). A particular histologic abnormality was seen (Figure D, arrow). What is the most likely diagnosis? Look on page 873 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

Resection of Large Pedunculated Rectal Polyp with Preinjection and Clips Followed by Roth Net Retrieval

Large pedunculated polyps in the colon and rectum represent a challenge to the endoscopist to resect in a controlled and safe manner. How stalk preinjection with epinephrine (adrenaline) can help avoiding immediate postpolypectomy bleeding has been demonstrated in the given video. Endoscopic clips are applied to the polyp base following polypectomy to reduce the risk of delayed bleeding. Retrieval with a Roth net is also demonstrated. This article is part of an expert video encyclopedia.

Endoloop-Assisted Polypectomy Technique

Endoscopic resection of large pedunculated colon polyps should be preferred over surgical resection; however, it carries the risk of associated significant postpolypectomy bleeding. With advances in endoscopic tools such as endoclips and endoloops, it has become safer to perform endoscopic resection of large pedunculated polyps. Herein are demonstrated some important aspects of the technique for endoscopic resection of a large pedunculated colon polyp. This article is part of an expert video encyclopedia.

Tu1505 Endoscopic Prevention of Postpolypectomy Bleeding in Large Pedunculated Colorectal Polyps: Single Method (Clipping Only) Versus Combined Method (Clipping Plus Epinephrine Injection)

Post-polypectomy bleeding (PPB) is the most common complication of colonoscopic polypectomy, accounting for 0.3 to 6.1 percent of polypectomy. Especially, pedunculated polyp is known to be a risk factor for PPB. The aim of the present study is to compare the rate of PPB in large pedunculated polyps with prophylactic clipping with that with prophylactic clipping plus epinephrine injection.

Handcrafted two-channel colonoscope for grasping forceps-assisted resection of large pedunculated polyps in the sigmoid colon

Handcrafted two-channel colonoscope for grasping forceps-assisted resection of large pedunculated polyps in the sigmoid colon

A Second Assisting Endoscope for the Removal of an Accidentally Unreleased Detachable Snare during Colon Polypectomy

The incidence of postpolypectomy hemorrhage ranges from 0.3% to 6.1%, and is the most common complication of polypectomy.1 The risk of bleeding may be especially high after resecting pedunculated polyps because of the presence of a large artery in the stalk. Bleeding can occur in the immediate postpolypectomy period, or may be delayed up to 29 days.2 Several endoscopic techniques have been developed. In 1989, Hachisu3 developed a detachable snare device that completely stops blood flow in the stalk. While loading the detachable snare, it is important to verify that it is properly attached to the hook wire and smoothly pulled into and then pushed back from the coil sheath without getting stuck.4 A second endoscope-assisted endoscopic submucosal dissection for large colorectal tumors has been reported recently.5-7 Here, we report a case in which an accidently unreleased detachable snare used for colon polypectomy was successfully removed by a second assisting endoscope. A 40-year-old man underwent screening colonoscopy. A grossly 1.5 cm-sized pedunculated polyp with a 3 cm-long stalk was observed at the distal descending colon. A detachable snare (MAJ-254; Olympus, Tokyo, Japan) was placed around the lower one-third of the stalk. The detachable snare could not be released from the hook wire of the operating part, as the loop of nylon thread appeared to be tightly stuck between the coil sheath and hook wire. Hence, the snare loop and coil sheath were attached to the colon polyp, and the colonoscope could not be retrieved (Fig. 1). Fig. 1 The unreleased snare observed by the second assisting endoscope. A second assisting gastroscope was inserted. The stalk was cutoff with a conventional snare between the snare loop and the polyp head. Cutting of the unreleased detachable loop with hot biopsy forceps and an insulation-tipped diathermic knife was then attempted, but failed. A conventional snare was placed just above the rubber stopper of the detachable snare (Fig. 2), and the detachable snare, which tightly strangulated the stalk, was successfully released from the stalk by cutting at that position, and all the specimens were retrieved (Fig. 3). No complications such as bleeding or perforation were noted during the 2 weeks of follow-up. Fig. 2 Snare resection of the stalk just above the rubber stopper. Fig. 3 Gross specimen of the removed polyp. Clinical evidence supports the usefulness of the detachable snare in the management of postpolypectomy bleeding, bleeding from esophageal and gastric varices, and angiodysplasias.4 The detachable snare was developed for the prevention of hemorrhage after the removal of large pedunculated polyps.1 Hence, the most probable reason for the detachable snare not being released was that it got stuck between the coil sheath and hook wire in this case. Several complications related to the detachable snare have been reported. It became entangled with the polypectomy snare in one patient, and the proper transection of peduncle failed in another patient.8 A slip-off of an endoloop slip-off in five of 53 patients, and delayed bleeding occurred in three of 53 patients, especially those with semipedunculated polyps.8,9 A second gastroscope may easily be inserted up to the descending colon without increasing the patient's discomfort and may efficiently act as another hand by lifting the dissected lesion during the dissection procedure.5-7 In our case, a second endoscope, however, was required for the successful removal of the unreleased snare and colon polyp, as the first endoscope was unsuccessful.

Prophylactic Clip Application Before Endoscopic Resection of Large Pedunculated Colorectal Polyps in Patients Receiving Anticoagulation or Antiplatelet Medications

The aim of the present study was to evaluate the safety of prophylactic endoclipping before resection of large pedunculated colorectal polyps in patients with uninterrupted anticoagulation or antiplatelet therapy. In a single tertiary referral center, patients with normal coagulation parameters and those with uninterrupted anticoagulation or antiplatelet medications, who underwent prophylactic endoclipping before resection of large pedunculated colorectal polyps (polyp's head diameter >10 mm), were evaluated retrospectively. Demographic, clinical, and laboratory parameters, polyp characteristics, number of clips used for endoclipping, histology of resected polyps, the polypectomy technique, and postpolypectomy complications were recorded and compared. In 64 patients with large pedunculated colorectal polyps, successful endoclipping before resection was achieved. Eleven patients (17.2%) had uninterrupted anticoagulation (n = 4) or antiplatelet (n = 7) medications. Statistical analysis showed no significant differences in age, sex, indications for colonoscopy, location of polyps, size of polyp head or stalk, coexisting small polyps, histology of resected polyps, and polypectomy techniques among patients with normal coagulation parameters (group A) and patients on uninterrupted anticoagulant or antiplatelet treatment (group B). Coronary artery disease, hypertension, and atrial fibrillation were significantly more prevalent in group B. No immediate or delayed postpolypectomy hemorrhage occurred in either group. One patient (1.9%) in group A developed postpolypectomy coagulation syndrome and was successfully treated conservatively. Follow-up evaluation demonstrated no recurrence of polyps or cancer development. According to our experience, uncomplicated polypectomy of large pedunculated colorectal polyps can be performed by prophylactic endoclipping in patients receiving anticoagulation or antiplatelet medications.

PMO-186 Complication rates of colonoscopic removal of large colorectal polyps in a district general hospital: a retrospective audit

IntroductionColonoscopic removal of large colorectal polyps, sessile or pedunculated, can pose a challenge. Techniques most commonly used are hot snare polypectomy or endoscopic mucosal resection using electrocautery snare. The bigger...

Is the use of prophylactic hemoclips in the endoscopic resection of large pedunculated polyps useful? A prospective and randomized study

The methods for preventing post-polypectomy bleeding (PPB) are not standardised and there are groups that use hemoclips for this purpose. To study whether the use of hemoclips reduces PPB complications. Prospective, randomised study of patients with pedunculated polyps larger than 10 mm. The patients were included in two groups (hemoclip before polypectomy -HC- and standard polypectomy -SP-). This study has been registered with the trial registration number NCT01565993. 105 polypectomies were performed (98 patients), 66 (62.9%) in the HC group. The total rate of complications was 10,6% in the HC group (4.5% early bleeding, 1.5% severe delayed bleeding, 4,5% mucosal burns, 1.5% perforation). In the SP group, the rate of total complications was 7,7%, (7,7% early bleeding, no significant differences). In view of the unexpected increase in the morbidity of the hemoclip group, the study was suspended without reaching the sample size. In an ad hoc analysis, which includes the standard polypectomy patients who refused to participate in the study (35 polyps), the total morbidity was 5,7% (no perforations and 2 patients with premature bleeding).When we compared the morbidity of the HC group to the morbidity of SP group plus R group (74 polyps), we also failed to detect any significant differences in terms of PPB, but did in terms of perforation. The prophylactic use of hemoclips in polypectomies of large pedunculated polyps leads to a further risk of mucosal burns and perforation that is not acceptable, and does not reduce the risk of PPB.

Is the use of prophylactic hemoclips in the endoscopic resection of large pedunculated polyps useful? A prospective and randomized study.

The methods for preventing post-polypectomy bleeding (PPB) are not standardised and there are groups that use hemoclips for this purpose. To study whether the use of hemoclips reduces PPB complications. Prospective, randomised study of patients with pedunculated polyps larger than 10 mm. The patients were included in two groups (hemoclip before polypectomy -HC- and standard polypectomy -SP-). This study has been registered with the trial registration number NCT01565993. 105 polypectomies were performed (98 patients), 66 (62.9%) in the HC group. The total rate of complications was 10,6% in the HC group (4.5% early bleeding, 1.5% severe delayed bleeding, 4,5% mucosal burns, 1.5% perforation). In the SP group, the rate of total complications was 7,7%, (7,7% early bleeding, no significant differences). In view of the unexpected increase in the morbidity of the hemoclip group, the study was suspended without reaching the sample size. In an ad hoc analysis, which includes the standard polypectomy patients who refused to participate in the study (35 polyps), the total morbidity was 5,7% (no perforations and 2 patients with premature bleeding).When we compared the morbidity of the HC group to the morbidity of SP group plus R group (74 polyps), we also failed to detect any significant differences in terms of PPB, but did in terms of perforation. The prophylactic use of hemoclips in polypectomies of large pedunculated polyps leads to a further risk of mucosal burns and perforation that is not acceptable, and does not reduce the risk of PPB.